Laparoendoscopic Single-Site Nephrectomy for Patients with Dialysis-Dependent End Stage Renal Disease
Sompol Permpongkosol MD, PhD*, Kullanan Nontakaew MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Objective : Assess the feasibility, safety, and outcome of laparoendoscpic single-site (LESS) nephrectomy in high-risk
patients with end-stage renal disease (ESRD), who have undergone continuous ambulatory peritoneal dialysis (CAPD) and
hemodialysis (HD) treatment.
Material and Method: Between October 2009 and January 2010, a 62-year-old female and a 36-year-old male that had
undergone CAPD and HD, respectively, consecutively underwent LESS nephrectomies. The medical records of the two
patients were retrospectively reviewed. The indications for nephrectomy were that the non-functioning kidney was associated
with a ureteric stone and distal ureteric stricture, respectively. Parameters examined were patient demographics, medical
co-morbidities, operative outcomes, and complications.
Results : All procedures were completed successfully via transumbilical LESS laparoscopy. The operative times were 160 and
200 minutes, blood loss 200 and 50 mL, and postoperative hospital stay 6 and 14 days, respectively. No intraoperative
complications were reported. The first patient who used CAPD before LESS nephrectomy for whom CAPD was successfully
reinstated within two weeks postoperatively. No other catheter-related complications occurred. The second patient required
a reoperation to evaluate the active bleeding on the fifth post-operative day, but could not find any blood vessel injuries. The
bleeding was stopped from the platelet replacement. Pathological evaluation revealed chronic glomerulonephritis in each case.
Conclusion : Less nephrectomy is a feasible technique with the advantages of less pain, shortened convalescence, improved
cosmesis, and absence of wound complications.
Keywords : Laparoendoscopic single site surgery, Nephrectomy end stage renal disease, Continuous ambulatory peritoneal dialysis
